Respiratory syncytial virus (RSV) is an enveloped, nonsegmented, negative-sense RNA virus in the family Paramyxoviridae. It is the leading cause of acute lower respiratory tract infections (ALRI) in young children and other high-risk populations worldwide (1). RSV infection has accounted for an estimated 34 million cases of ALRI and over 66,000 deaths among children younger than 5 years in developing countries each year (2). The association of RSV infection with morbidity in elderly patient populations with underlying chronic illnesses (e.g., chronic obstructive pulmonary disease, asthma, and immunocompromised patients) has also been increasingly recognized in recent years (3, 4). Despite decades of research and drug development endeavors, no effective RSV treatment or vaccine is available (1). Ribavirin, a panantiviral and the only approved small-molecule therapy against RSV, has an unclear molecular mechanism of action (MoA) and restricted clinical utility due to its toxicity, limited efficacy, and complexity of use (5). Immunoprophylaxis with RSV-neutralizing antibodies is effective only as a preventive measure, but not as a therapeutic treatment (5).In the past 2 decades, RSV inhibitors in clinical development for RSV therapeutic treatment have primarily targeted viral fusion to prevent infection of new cells. Other early clinical candidates included the small interfering RNA (ALN-RSV01) (6, 7), nucleoside inhibitor (ALS-8176) (8), and nucleoprotein (N) inhibitor (RSV604) (9). These inhibitors have yet to show reported therapeutic efficacy in the clinic against natural RSV infections (10). In two recent phase 2a RSV challenge studies with adult volunteers, the fusion inhibitor GS-5806 (Gilead) and the nucleotide inhibitor ALS-8176 (Alios) demonstrated a reduction in disease symptoms and viral load when dosed at a relatively low viral load and before the onset of symptoms (11). In a phase 2a trial in stem cell transplant patients with RSV infection, RSV604 reduced the viral load and symptoms in the subset of patients with RSV604 plasma exposure reaching 1Ï« the 90% effective concentration (EC 90 ), though not in those with less plasma exposure (12).Of the 11 RSV-encoded proteins, N is one of the most conserved structural proteins and is essential for virus encapsidation by coating the entire viral RNA genome to form the ribonucleoprotein (RNP). Although poorly understood, this multifunctional protein was also found to play an important role in viral RNA replication, mRNA transcription, and virus assembly (3). RSV604, discovered through chemical optimization of an RSV high-throughput screen hit, was reported to be an N inhibitor based on the identification of resistance mutations in the N gene in the escape viruses (9, 13). However, the MoA and mechanism of resistance for the compound were unclear. The MoA of another class of negativestrand RNA virus nucleoprotein inhibitors, aryl piperazine amides, such as nucleozin, is through inducing nucleoprotein aggregation and altering its localization in influenza virus...